COVID-19 Medical Plan Coverage Programme - Flyer
COVID-19 Medical Plan Coverage Programme - Flyer
COVID-19 Medical Plan Coverage Programme - Flyer
Great Eastern Life Assurance (Malaysia) Berhad (93745-A) is licensed under the FInancial Services Act 2013 and is regulated by Bank Negara Malaysia.
Menara Great Eastern, 303, Jalan Ampang, 50450 Kuala Lumpur.
Frequently Asked Questions
Q: What is the COVID-19 Medical Plan Coverage Programme?
A: The COVID-19 Medical Plan Coverage Programme (”Programme”) is a special programme that provides complimentary RM20 million goodwill
medical coverage on COVID-19 to all life assured of Great Eastern Life (”the Company”) who own any of the eligible medical plans.
Any reimbursement provided under this Programme will NOT reduce the overall annual or lifetime limits of the eligible medical plan(s).
* Except for the general exclusion in the medical policies referring to communicable diseases requiring quarantine by law where COVID-19 coverage
is excluded. Throughout the duration of this Programme, the eligible medical plans do not exclude COVID-19 coverage.
Smart Extender Max Great Medic Xtra Great Extender Smart Premier Health*
* Withdrawn plans.
Great Eastern Life Assurance (Malaysia) Berhad (93745-A) is licensed under the FInancial Services Act 2013 and is regulated by Bank Negara Malaysia.
Menara Great Eastern, 303, Jalan Ampang, 50450 Kuala Lumpur.
Frequently Asked Questions
Q: Is there any additional premium or insurance charge for this Programme?
A: No, there is no additional premium or insurance charge that the life assured has to pay to enjoy the protection provided under this Programme -
it is complimentary and provided by the Company on a goodwill basis.
Q: Will the COVID-19 claims cost from this Programme impact future repricing of the eligible medical plans?
A: No, the total COVID-19 claims paid from this Programme will be on a goodwill basis by Great Eastern Life. Hence, the cost will not be considered
as part of the adverse claims experience contributing to future repricing of medical plans.
Q: Would the life assured be reimbursed for COVID-19 diagnostic tests and/or Personal Protective Equipments (PPEs) used during
such Medically Necessary hospitalisation?
A: Yes, COVID-19 diagnostic tests and usage of PPEs during such hospitalisation due to COVID-19 infection will be reimbursed based on the
Reasonable and Customary Charges of the eligible medical plan(s).
Q: Is the life assured covered under this Programme for expenses incurred for in-hospitalisation treatment or subsequent
complications due to COVID-19 / if the life assured is hospitalised as a result of a recurring COVID-19 infection?
A: Yes, as long as the reimbursement is for Reasonable and Customary Charges incurred for Medically Necessary treatment received by the life
assured while hospitalised due to COVID-19 during the Coverage Period.
Great Eastern Life Assurance (Malaysia) Berhad (93745-A) is licensed under the FInancial Services Act 2013 and is regulated by Bank Negara Malaysia.
Menara Great Eastern, 303, Jalan Ampang, 50450 Kuala Lumpur.
Frequently Asked Questions
Q: Is the life assured covered under this Programme for pre-hospitalisation and/or post-hospitalisation expenses incurred?
A: Yes, provided the life assured’s medical plan is an eligible medical plan under this Programme that provides coverage for pre- and
post-hospitalisation expenses.
Q: If the hospitalisation due to COVID-19 happens overseas, is the life assured still eligible for this Programme?
A: Yes, the life assured is still eligible for this Programme. Claims will be processed based on the terms and conditions of the respective eligible
medical plan(s), including clauses related to Reasonable and Customary Charges and Residence Overseas.
Q: If the life assured has made a claim under any of the Company’s other COVID-19 goodwill initiatives (e.g. Financial Assistance
Programme, COVID-19 Vaccine Fund, COVID-19 Private Hospitalisation Assistance Programme), is he/she still eligible for this
Programme?
A: Yes, the life assured is still eligible for this Programme, as long as he/she fulfills the eligibility criteria.
Q: If the life assured holds multiple policies from more than 1 insurance company, can he/she still be reimbursed under this
Programme?
A: Yes, the life assured can still claim from this Programme, subject to meeting the terms and conditions and based on the principle of indemnity -
e.g. the life assured may be first claiming from another insurance company, if any, and the Company will indemnify the balance eligible medical
expenses up to the benefit limit of their eligible medical plan.
Q: If the life assured has a medical plan which does not have the exclusion clause on communicable diseases requiring quarantine
by law, is he/she still entitled for this Programme?
A: No, this Programme is only for life assured of medical plan(s) with the exclusion clause on communicable diseases requiring quarantine by law.
Medical plans which do not have this exclusion clause are already covered for COVID-19 treatment, subject to the features, benefits, and terms
and conditions of the plan(s).
Q: Can the life assured submit a claim under this Programme if he/she is a Category 1 or 2 COVID-19 patient but was recommended
by his/her doctor to be hospitalised?
A: In general, for a COVID-19 patient with no symptoms (Category 1 - asymptomatic) or who does not require active treatment i.e. in quarantine only
(Category 1 - asymptomatic; or Category 2 - symptomatic, no pneumonia), any services received during such hospitalisation including quarantine
at quarantine centres, quarantine at hospitals, or home quarantine would not be deemed as Medically Necessary. Hence, the expenses incurred
will not be reimbursed under this Programme, unless there is evidence showing the hospitalisation and treatment received are Medically
Necessary and active treatment is required for the patient during the hospitalisation.
For the latest information on COVID-19 treatment categories, please refer to the official MOH website here:
http://covid-19.moh.gov.my/garis-panduan/garis-panduan-kkm
Great Eastern Life Assurance (Malaysia) Berhad (93745-A) is licensed under the FInancial Services Act 2013 and is regulated by Bank Negara Malaysia.
Menara Great Eastern, 303, Jalan Ampang, 50450 Kuala Lumpur.
Frequently Asked Questions
Q: If the life assured progresses from being a Category 2 COVID-19 patient to a Category 4 COVID-19 patient and is hospitalised in
Malaysia for Medically Necessary treatment, can he/she submit a claim under this Programme?
A: Yes, as long as the COVID-19 treatment is Medically Necessary. Claims will be assessed based on the terms and conditions of the Programme,
and are subject to the limits of his/her eligible medical plan.
Q: Will there be any guaranteed letter issued if the life assured is hospitalised due to COVID-19?
A: No, any claim from this Programme will be paid solely on a medical reimbursement basis.
Cashless facility is not applicable for hospital admissions where the life assured is diagnosed with COVID-19 - e.g. when a life assured is admitted
to a private hospital for non-COVID-19 related treatment and also tested positive for COVID-19, cashless admission is NOT applicable and no
guaranteed letter (GL) will be issued.
Q: If the life assured is admitted for other conditions that are not related to COVID-19 and subsequently becomes COVID-19 positive,
is cashless facility available for the entire hospitalisation?
A: No, even if the other conditions are covered on a cashless basis, all Reasonable and Customary Charges related to Medically Necessary treatment
for the COVID-19 infection will only be covered on a reimbursement basis.
Q: Can the life assured submit a claim under this Programme if he/she was quarantined in a hospital, quarantine centre, or
makeshift hospital for COVID-19 infection?
A: No, claims for quarantine are not payable under this Programme.
Q: Are there any other terms and conditions applicable to this Programme?
A: The following terms and conditions apply:
. A 30-day waiting period applies from either the risk commencement date / risk effective date of the eligible medical plan / rider, or
reinstatement date of the policy, whichever is later.
. The eligible medical plan / rider must remain inforce upon diagnosis of COVID-19, during the treatment due to COVID-19, and upon claims
submission.
. The Company reserves the right to change and/or terminate the Programme earlier, should the prevailing conditions and circumstances
change.
Great Eastern Life Assurance (Malaysia) Berhad (93745-A) is licensed under the FInancial Services Act 2013 and is regulated by Bank Negara Malaysia.
Menara Great Eastern, 303, Jalan Ampang, 50450 Kuala Lumpur.
Frequently Asked Questions
Q: How do I make a claim?
A: Please refer to the “Make A Claim” page here:
https://www.greateasternlife.com/my/en/personal-insurance/get-help/claims.html
The claim submission date by the eligible life assured must occur within the Coverage Period of the Programme, and will be taken to be the date
of submission and acknowledgement of receipt of all required documents.
Great Eastern Life Assurance (Malaysia) Berhad (93745-A) is licensed under the FInancial Services Act 2013 and is regulated by Bank Negara Malaysia.
Menara Great Eastern, 303, Jalan Ampang, 50450 Kuala Lumpur.